Angus Reid Survey and NB’s Unhappiness with Health Services

“NBers unhappy about health system, survey suggests”; so, said the headline in the Fredericton Daily Gleaner on Saturday, October 14, 2023.  The article was based on an Angus Reid national poll that interviewed 5,010 Canadians of which 285 were New Brunswickers.
I presume statisticians may consider those numbers are “statistically significant” but I would doubt that any serious business would make expansion or re-structuring decisions based on survey samples that are a tiny fraction of 1% of the population.  But where there is smoke there is fire.  Even with a small sample size, those in charge of program delivery need to pay attention because the poll at least indicates a need to dig further.  It did suggest, for instance, that those who responded had little confidence in government to deliver on its promise of reform.

One of the dangers of polls and headlines is that the great people in the system who perform with skill and compassion get swept up in the broad assessment of the health system.  The truth is that when you need emergency (life sustaining) treatment, some key elements of the system are there with great efficiency.

The NB Heart Centre, the wonderful professionals who perform cancer care, joint replacement or urologic surgery leave patients singing their praises.  New Brunswick does have some great clinical services and we need to celebrate those and lean on government and the health authorities to move mountains to make their work professionally satisfying and efficient.

So, what is the source of the unhappiness determined by Angus Reid?  One place to start is with understanding the inconsistency in quality and responsiveness.  In the last few weeks, two of those who have shared their experiences with me were patients who presented at hospital with what looked like life-threatening conditions.  In one case, the patient’s symptoms were attacked with urgency and determination very quickly, the result being that the patient recovered well, was discharged after a few days, and sings the praises of doctors and nurses who got him through the ordeal.

From another in a different hospital, quite a different picture; similar initial symptoms, seeming lack of aggressiveness with quite a different result.

Then we hear from the patient on the list for painful months for hip replacement surgery only to find that if she were prepared to go to another city in NB, she could get the surgery in a couple of weeks.

Also, we hear from the high-risk patient who needs emergency consultation only to be greeted with a sign on the door: “wait time 18-19 hours”.  

How about the post-op senior patient with serious bleeding who, similarly, sits for hours until she, as well, decides to depart and return home to cope as best she can, or the post-op person in intractable pain who waits for 11 hours then goes home, still in pain.

The recruitment of professional staff is a major issue and the health authorities are embarking on many initiatives to attract personnel.  There are many moving parts that make their jobs difficult and having health facilities known for terrific working relationships is always the best place to start.

The health authorities seem to be doing some good things with workplace culture as one step in making the workplace a more positive environment, and that is to be commended.  The core issues of job satisfaction, that make or break a workplace environment, however, is leadership.  All those doctors, nurses, and other health professionals who have management responsibility desperately need strong leadership development and clear job descriptions with accountability defined.  Some are seeking out some of that education themselves.  History has shown that some in those positions needed to have the mandatory training to serve either as skill development or an exit ramp.

The indicators of workplace culture issues have been outlined in literature over the years as including:

1. Employee absenteeism:  there are many reasons why employees take excessive sick days and often stress in the workplace is at or near the top.  And who is responsible for the healthy workplace?  The Charge Nurse or immediate unit supervisor, then you follow the chain to the executives and to the CEO.  Pure and simple.  And if the board is not knowledgeable of how important the workplace culture is and what it takes to create and maintain that culture, shame on them.
2. Workers’ compensation claims:  Worksafe is there to protect employee’s health and income status.  But Management is on the line for ensuring that staff have what they need to maintain a safe (physically and mentally) work environment.  Good management can get the rate of claims decreased with strong focus on the issue.
3. Staff Turnover:  stories of great nurses moving on to other careers, usually out of health care, are disturbing, particularly when you speak with them individually to ascertain their “why”. 
4. Observations of professional interactions with patients and colleagues, or Management by Walking Around.

Those long waits in the Emergency Departments, and the other major issues that compromise service to the public, are manageable but not by using current strategies and traditional thinking.  The Health Authorities must take ownership of the array of pre-hospital primary care services and take bold steps to ensure that the service gaps are filled.  This, again, is about leadership. 

New Brunswick needs to seek out some expertise on the international scene to help with introducing some new (for New Brunswick) directions.  In the long Emergency Department waits, for instance, there are some great success stories across the continent and we should not be too proud to seek them out and learn from them.  Similarly with workplace culture, there are centers of excellence across the continent from whom NB can and must learn.  We owe it to those thousands of wonderful staff who have chosen a career path with noble goals, ideals and values.

Responding to the Angus Reid survey cannot be left to government, the health authorities, or the Premier’s office alone.   The issues have not changed in years; the environment has changed; practice patterns have changed, and the marketplace has changed.  It takes courageous, informed, experienced, nimble leadership to right this ship.

Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com​